DESCRIPTION (provided by investigator): This is a revision of "Effects of Prenatal Cocaine Use: 15-Year Follow-Up" (R01 DA08916-A1). Long-term effects of cocaine exposure during pregnancy and effects of cocaine use on the child's environment are major public health concerns. However, very little information exists regarding these effects. This is an application to define the long-term effects of prenatal cocaine exposure with a large, well-established cohort of substance-using women and their offspring. In this unique study of prenatal cocaine use, women were enrolled early in pregnancy, trimester-specific information was collected, and the children have been assessed at regular intervals through age 10. We have exceptional followup rates, detailed assessment of all substance use in the prenatal and postpartum periods, careful measurement of other characteristics, particularly environmental variables, and a comprehensive child assessment battery. We have demonstrated that prenatal cocaine exposure has consistent effects on the development of the CNS. At birth, we found neurological and neurobehavioral effects. At 1 and 3 years of age, children exposed to cocaine were fussier and more difficult. There was also a significant interaction between age and prenatal exposure, showing a significant increase in difficult temperament between 1 and 3 years among the cocaine-exposed children. At 3 years, prenatal cocaine use significantly predicted poorer short-term memory and increased behavior problems. At age 7, prenatal cocaine use predicted increased attention and behavior problems. At 10 years, prenatal cocaine exposure predicted poorer neuropsychological performance, increased behavior and attention problems, and increased symptoms of depression. Thus, through the age of 10 years, children exposed to cocaine show increased behavior and attention problems, changes in temperament and mood, and cognitive and neuropsychological deficits. There were also significant effects of prenatal cocaine exposure on growth at each phase. This is an application to assess the cohort at 15 years of age. This is an important developmental period as it is the early years of high school, a time of change and stress, and of introduction into the social and substance-using world of older adolescents. It is also an important time for physical and CNS maturation. The conjunction of these elements may be particularly critical for the prenatally exposed adolescents who by age 10 were already showing neuropsychologicel deficits, behavior and attention problems, and mood disturbances. Our hypotheses are: (1) at age 15, the effects of prenatal cocaine exposure will continue to be manifested as deficits in growth, problem-solving and mental flexibility, behavior and attention problems, and mood; and (2) antecedent risk factors, such as a poor home environment, parental substance use, conduct disorder, and the effects of prenatal substance use, will predict drug and alcohol use among the 15 year olds.